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Respiratory > Chest Infection > Flashcards

Chest Infection Flashcards

1
Q

What are the commonest causes of community-acquired pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
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2
Q

What are the necessary considerations when giving respiratory antibiotics?

A
  • Consider spectrum, route of administration, bioavailability and duration.
  • Consider goal of treatment - cure, control, maintenance - ‘immune modulation’.
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3
Q

What are the principles of basic practice when dealing with respiratory infections?

A
  1. Basic microbiology
    • Respiratory microbiology - commensal organisms vs. respiratory pathogens.
  2. Basic antibiotic biology
    • Respiratory antibiotics
  3. Basic immunology
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4
Q

Give an overview of the body’s defences against infection.

A
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5
Q

What is sepsis?

A

A life-threatening organ dysfunction caused by a dysregulated host response to infection.

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6
Q

What is septic shock?

A
  • A subset of patients with sepsis acquire septic shock.
  • They have profound circulatory, cellular and metabolic abnormalities.
    • MAP <65mmHg
    • Lactate >3mmol/L
  • Consider sepsis alongside consideration of pneumonia and antibiotics.
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7
Q

Describe the management of URTIs.

A
  • Supportive, not antibiotics (probably).
  • Special diagnoses - stridor, croup, quinsy.
  • Consider underlying diagnosis - allergy, polyps, immunity.
  • Consider ENT review and direct nasendoscopy.
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8
Q

Describe the management of LRTIs.

A
  • Supportive, maybe with antibiotics.
  • Consider related morbidity - URT, LRT, asthma, chronic cough.
  • Mack a back-up plan - consider CXR, antibiotics and referral.
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9
Q

Describe the management of pneumonia?

(Confirmed by consolidation on chest imaging).

A
  • (Supportive)
  • Yes, antibiotics. Difficult not to, even if it is likely a virus.
  • Decisions on antibiotic choice (spectrum), duration (5-7-10 days).
  • Consider underlying diagnoses - allergy, polyps, immunity, comorbidities, bronchiectasis, COPD.
  • Consider admission.
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10
Q

Describe the management of empyema.

A
  • Definitely antibiotics!
  • Definitely drain!
  • Supportive - comorbidities, psychosocial, pain (drain), oxygen.
  • Consider underlying diagnosis - pathogen, immunity.
  • Surgery? Thoracoscopy?
  • ‘Medical treatment’ second choice - 6 weeks+ antibiotics.
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11
Q

Describe the management of bronchiectasis.

A
  • The first priority is airway clearance. Must clear the airways of pus to reduce the chance of pneumonia and infection.
  • Cyclical antibiotics!!
  • Long-term chronic lung disease, ‘management plan’, specialist nurses, interested GPs, motivated patient, preventative therapies, rescue therapies.
  • Consider exacerbation of BE vs pneumonia vs progression.
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12
Q

Describe the management of lung abscess and cavitation.

A
  • Definitely antibiotics. Inhaled / intravenous / oral.
  • Treatment is defined by cause.
  • Identify the pathogen.
  • ‘Medical treatment’ first choice - 6 weeks+ antibiotics.
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13
Q

What is Aspergillosis pneumonia?

A

Infection in response to the aspergillus fungus.

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14
Q

What is granulomatous polyangiitis (GPA)?

A

Disorder causing inflammation of the blood vessels in the nose, sinuses, throat, lungs and kidneys.

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15
Q

Discuss community acquired pneumonia. Specifically:

  • Definition
  • Incidence
  • Aetiology
  • Sex differences
  • Geographical differences
  • Pathology
  • Symptoms and signs
  • Prognosis
A
  • Definition: clinical features of penumonia + radiology.
  • Incidence: 1% adults; 5-10% of GP presentations with ‘LRTI’.
  • Aetiology: virus, bacteria (strep, H. infl.), co-infection.
  • Sex: same in incidence; possibly slightly worse outcomes F>M.
  • Geography: relevant in aetiology and outcomes (socio-economic).
  • Pathology (MM): consolidation, pus/necrosis, nph/lph/eos.
  • Symptoms and signs: cough + phlegm, SOB, fever.
  • Prognosis: consider CURB65: <1% → 50%; consider CAP/HAP.
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16
Q

How long would antibiotics be needed in patients with pneumonia?

A
  • 5-7 days; 3 days may be sufficient (pneumococcus).
17
Q

How long would antibiotics be needed in patients with deep seated infection?

A

14 days

18
Q

How long would antibiotics be needed in patients with empyema?

A

4-6 weeks

19
Q

How long would antibiotics be needed in patients with cavitation?

A
  • Pyogenic > 6 weeks.
  • TB - 6 months.
  • Nontuberculosis myobacteria (NTM) - 18 months.
20
Q

What are the characteristics of hospital acquired pneumonia?

A
  • Includes >48 hours after admission - or within 10-30 days of discharge.
  • Radiographic change - pneumonia, effusion, empyema.
  • Altered microbiological context - gram-negative, anaerobes; MRSA, (C. difficile).
  • Worse outcomes - 25-50% mortality.

Respiratory (13 decks)

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